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2 July 2020
We explore some of the challenges and triumphs our primary care colleagues experienced when managing patients during the pandemic and share some important lessons learned.
When coronavirus started spreading rapidly earlier this year, primary care teams had to quickly develop new ways to provide services whilst keeping patients and staff safe.
In south east London (and beyond) teams came together to redesign a number of primary care centres into services caring solely for patients with suspected COVID-19. This reconfiguration went from a design on paper to implementation within a matter of weeks. This was something that primary care had never had to do before and embodied the strong sense of working together to best support patients - something which the NHS has symbolised during the pandemic.
Dr Rachna Chowla, King’s Health Partners Joint Director of Clinical Strategy, who leads on our collaborations with primary care, and one of our Darzi Fellows, Dr John McGuinness, worked closely on this vital project.
These new centres became known as COVID-19 community assessment centres. In this new COVID-focused primary care model, all initial contacts were done remotely by primary care – online, or via video or phone calls, including using the 111 service. If the clinician determined that a patient with suspected COVID-19 symptoms still needed to see a GP face-to-face, then they would be referred to a COVID-19 community assessment centre for a rapid assessment that same day.
These centres used resources in a safe way to ensure patients and primary care teams were protected and the risk of spreading the disease was minimised.
The establishment of these new centres would not have been possible without the hard work and dedication of colleagues in primary care. The speed at which these centres were set up and the processes put in place to ensure the safety of patients and staff was astonishing and demonstrated the strength of partnership working and existing relationships.
The rapid setting up, and in recent weeks, scaling down, of COVID-19 assessment centres has had its challenges, but the process has had a fundamentally positive impact on the collaboration and development of primary care networks across south east London.
We take a look at some of the key learnings and challenges colleagues found when establishing COVID-19 community assessment centres.
1. The need for fast decision-making
Decisions on the new model of care had to be made quickly and involved a vast numbers of stakeholders. Primary care colleagues often had no more than a day to make big decisions about changes to services. It was vital to consider the various options; the views of those involved and the potential impact changes could have on services for patients and staff. There was recognition that colleagues were all doing their best with the information available. There was also a sense of openness to learning from others in different Clinical Commissioning Groups, as well as humility in order to review decisions and quickly adapt based on new information.
2. Understanding the demand for the service
A big challenge was trying to gauge the demand for the service. It was vital to be prepared for a high number of patients potentially presenting with COVID-19 symptoms and being able to meet their health needs. Working from best estimates and forecasts provided by King’s Health Partners (Prof Kenji Shibuya from the Institute of Population Health at King’s College London and Dr Rachna Chowla) it was possible to predict the number of patients requiring the service. This enabled operational planning to take place. Interestingly, these anticipated figures exceeded real demand, which was true not only in south east London, but nationally.
3. Staff engagement
Central to the success of COVID-19 assessment centres was making sure staff felt confident about the new systems and procedures in place, and therefore psychologically safe.
The centres focused on having clear processes and messages for staff regarding changes to procedure and the centre’s layout. For example, an induction video was created for staff joining the South Southwark COVID-19 community clinic:
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Primary care colleagues also used blogs to explain how staff’s roles would change in these new environments.
One Health Lewisham, for example, shares a story from one Waldron Centre’s “hot site streamer” – who is responsible for welcoming patients to the clinic, to ensure they are wearing appropriate personal protective equipment.
4. Effective triaging
A real benefit for patient care that stems from these COVID-19 assessment centres’ changes is the use of effective triaging.
Online, telephone or video consultations allow practitioners to access a lot of information about a patient in a safe environment, without requiring them to come into a clinic. If a patient needs to come into a clinic, the clinician has a fuller picture about their health prior to meeting them. This gives more structure and ideally targeted care for the patient during their face-to-face consultation.
Not only has this method been vital during the pandemic, it could have long-term positive implications for patient-centred care.
5. Bringing the community together
Working collaboratively with support from the community has hugely contributed to the success of the new clinics. This was apparent at One Health Lewisham, where healthcare colleagues worked together to effectively run the clinic and the community donated money and scrubs - for example through ‘For the Love of Scrubs’. Members of the community also volunteered at the new centre.
Other ways colleagues showed creativity and innovation in setting up COVID-19 assessment centres can be seen in Southwark South’s centre use of black cabs. Taxis were not just used to safely transport suspected COVID-19 patients to clinics, but in some cases, patients were assessed physically outside the clinic in a black cab. This enabled patients to be check in a safe way and avoided bringing the risk of infection physically into the clinic.
Looking to the future, there is an interesting opportunity for us to explore COVID-19 community assessment centres’ processes and how the model can be adapted for the benefit of primary care.
With the support of King’s Health Partners’ Joint Director of Clinical Strategy’s, Natasha Curran, connections with Health Innovation Network (HIN), Andrew Walker and colleagues from HIN are beginning a new evaluation project, using quantitative and qualitative analysis, into the rapid development and implementation of COVID-19 assessment centres and how it could inform future care.
Prof Rick Iedema, Director for Centre for Team-Based Practice and Learning in Healthcare at King’s College London, along with colleague Dr Andreas Xyrichias, is researching what we can learn from team working in COVID-19 community assessment centres. No doubt the crisis has made healthcare teams more resilient, but has it meant teams work better together? Stay tuned for further details on Andrew’s and Rick’s research.
Talking about COVID-19 assessment centres, Dr Rachna Chowla, Joint Director of Clinical Strategy at King’s Health Partners, said:
I was involved most closely in the Southwark response as I am a GP here. I really admire the way colleagues across our local system came together to respond to the crisis. We were galvanised by a shared vision, happily forgot the usual organisational boundaries and just worked together to find the best solutions we could for our patients and for our practices which was delivered by our wonderful primary care networks.
There was such a strong sense of joint purpose and it also felt like we were racing against time, so a real sense of urgency. But the sense of teamwork was amazing – the Federations, the Clinical Commissioning Group and practices coming together.
Another key learning was the need to having to adapt to the constantly changing landscape, and also to learn, in real-time, and respond to what was happening around us.
From a King’s Health Partners perspective, it was also great to be able to link in Prof Kenji Shibuya, who helped with the modelling and also brought the evidence around Singapore’s Fever Clinic model, to early Southwark meetings. And Prof Idema and Dr Andreas Xyrichias, who started researching how teams came together and worked in such uncertain, unpredictable and changing environments, but found a way of providing high-quality, patient-centred care.
King’s Health Partners would like to build further on these types of partnership working – where we bring academia and primary care closer together, to collaborate on projects that have a direct and positive impact for our patients and our colleagues.
On 22 July we will be hosting the first in a new King’s Health Partners webinar series called “Meet the experts: different perspectives on COVID-19 from primary care and the wards.” Register your place.
A big thank you to a number of primary care colleagues who made the time to talk to us about their experiences of COVID-19 assessment centres, including Tilly Wright, Director Quay Health Solutions CIC, Southwark North COVID-19 Assessment Centre; Dr Gavin McColl, GP Partner at Hurley Group, Southwark South COVID-19 Assessment Centre; Dr Prad Velayuthan, Chief Executive One Health Lewisham; Dr Rob Gamage, Interim Clinical Services Director, One Health Lewisham; Andrew Walker, Health Innovation Network; Prof Rick Idema, King’s College London; Dr John McGuinness, King’s Health Partners Darzi Fellow; Sukh Singh, NHS Bexley Clinical Commissioning Group; Jean Young Associate Director of Healthy Populations and Community Based Care NHS South East London Clinical Commissioning Group.
